46 C.F.R. Exhibit No. 2 to Subpart S [§502.304(e)] of Part 502—Respondent's Consent Form for Informal Adjudication


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PART 502—RULES OF PRACTICE AND PROCEDURE
Subpart S—Informal Procedure for Adjudication of Small Claims

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Exhibit No. 2 to Subpart S [§502.304(e)] of Part 502—Respondent's Consent Form for Informal Adjudication

Federal Maritime Commission, Washington, DC.

Informal Docket No. ___

Respondent's Affidavit

I authorize the Settlement Officer to determine the above-numbered claim in accordance with subpart S (46 CFR 502) of the Commission's informal procedure for adjudication of small claims subject to discretionary Commission Review.

(Date) ____________________
(Signed) ____________________
(Capacity) ____________________

Verification

State of ___________, County of __________, ss: ______, being first duly sworn on oath deposes and says that he or she is _________, (Title or Position) and is the person who signed the foregoing and agrees without qualification to its truth.

____________________

Subscribed and sworn to before me, a notary public in and for the State of ________, County of ________, this ______ day of __________, 19__.

(Seal)

____________________

(Notary Public)

My Commission expires.____________________

Certificate of Service [See §502.320]

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